HRL Presentation

1. It’s All Elementary: Strategies to Connect
K-5 Students to Health Care
Healthy and Ready to Learn Webinar Training
November 29, 2011

2. Webinar Agenda
Healthy and Ready to Learn Project
It’s All Elementary: Strategies to Connect K-5 Students to Health Care
1:30 pm – 1:40 pm: Welcome and introduction to Healthy and Ready to Learn project in 2012
Steve Shore, Executive Director, NC Pediatric Society;
Ania Boer, HRL Project Director
1:40 pm – 1:55 pm: Health Check (Medicaid) and NC Health Choice (SCHIP) – children’s health insurance
programs in North Carolina
Norma Martí, Public Health Minority Outreach Coordinator, NC DPH
1:55 pm - 2:10 pm: School outreach strategies and HRL Action Steps for 2012
Betty Macon, India Foy, Laura Brewer
2:10 pm – 2:20 pm: School nurses and School Health Advisory Councils
Clementine Buford, Immediate Past President, School Nurse Association of NC
Jessica Gerdes, State School Nurse Consultant, NC DPH
2:20 pm – 2:30 pm: Q&A

3. N.C. Healthy and Ready to Learn Project:
• Funded by CHIPRA in 2009
Children’s Health Insurance Program Reauthorization Act
• 16 high-need pilot counties outreach in 2010
• 32 counties added in 2011
• Continuation funded by NC Office of Rural Health and
Community Care from Oct. 2011 until Sept. 2012
– Expansion from kindergarten students to all
elementary school students
– 60 LEAs in 46 counties

4. Healthy and Ready to Learn Initiative
Child Health Insurance Outreach Schools
Includes Elkin City & Mount Airy City
Includes Lexington City & Thomasville City Includes Weldon City & Roanoke Rapids
Includes Asheboro City
Includes Mooresville City Alleghany Northampton
Ashe Gates Camden
Surry Stokes Rockingham Caswell Person
11 Vance Warren Currituck
17 Granville 10 Hertford Pasquotank
Watauga Halifax
Wilkes Perquimans
Includes Yadkin 11
13
Asheville City Avery Forsyth Orange Chowan
42 Guilford Alamance Franklin
69 Bertie
Mitchell 21 Durham
Caldwell Nash
Yancey Alexander Davie 29 17 Edgecombe
Madison Iredell 5
Martin Washington
21 Davidson Wake Tyrrell
McDowell Burke 5 Dare
22 Randolph Chatham Wilson Pitt
17
Catawba Rowan 23 20
Buncombe 25 20 Beaufort
Haywood 26 Johnston Hyde
Swain Lincoln Greene
Rutherford Cabarrus Lee Harnett 22
Graham Henderson 1o 24 Montgomery 8 12 Wayne
Jackson Polk Cleveland Gaston Stanly 5 15
18 29 Mecklenburg 16 Moore Lenoir
Transylvania 8 Craven
Macon Pamlico
Cherokee Cumberland 15
7 Clay 48
Includes Hickory Union Anson Richmond Hoke Jones
Duplin
City & Newton 29 6 9 Sampson 8
9
Conover City Scotland Carteret
9
Onslow
CONTACT: Includes Kannapolis City Robeson Bladen
19
Ania Boer, Project Director, (ania@ncpeds.org, 919-839-1156) 23 7
Pender
Local Community Coordinators:
Columbus
Laura Brewer (laura@ncpeds.org, 910-865-5507) 10
New Hanover
24
Anson, Bladen, Brunswick, Buncombe, Cherokee, Cleveland, Columbus, Cumberl Brunswick Includes Clinton City
and, Davidson, Gaston, Montgomery, New 9
Includes Whiteville City
Hanover, Randolph, Robeson, Rutherford, Scotland, Richmond, Union.
Betty Macon (betty@ncpeds.org, 252-822-3340)
Craven, Duplin, Durham, Edgecombe, Halifax, Harnett, Johnston, Lee, Lenoir, Ma
Total of 46 counties
rtin, Nash, Onslow, Pitt, Sampson, Vance, Wayne. (60 LEAs)
India Foy (india@ncpeds.org, 336-617-6628)
Alamance, Burke, Cabarrus, Catawba, Forsyth, Guilford, Iredell, Rockingham, Ro
wan, Stanly, Surry, Wilkes.

5. N.C. Healthy and Ready to Learn project:
• School-targeted outreach and enrollment effort to register all
“eligible and uninsured” children in elementary school into child
health insurance programs Health Check or NC Health Choice
• Partnership of Local Education Agencies, School Nurses, SHACs,
State Agencies (DPI, DPH, DMA), Physicians and community-
based organizations, supported by the Office of Governor and
State Superintendent
• HRL Steering Committee has 44 members
• Identifies uninsured students through school outreach
and the Kindergarten Health Assessment form

6. Why is Healthy and Ready to Learn important?
• It complements one of the State Board of Education goals:
“Healthy and responsible students”
• Students need to be healthy to learn and graduate from
high school
• Students’ health status is linked to absenteeism and
performance
• Children learn about healthcare system by experiencing it
• All children need healthcare coverage and medical home to
stay healthy
• More children need health insurance in economic recession
Healthy children learn better!

7. HRL Grant Agreement 2012

8. HRL Grant Agreement
A. The XXX Schools will receive a $1,000 grant per county for LEA use at
discretion to offset modest expenses and:
1. Designate a school representative, such as school nurse or school
office/administrative staff, to be a contact person to assist the NC
Pediatric Society Foundation’s outreach efforts to find uninsured
elementary school students, and to participate in the training Webinar to
be held at 1:30 pm on November 29, 2011 (details will follow);
2. Use the HRL grant for: staff time to assist with tasks like distributing
Health Check/ NC Health Choice outreach materials, paying for school
nurses to participate in professional development, organize SHAC
meetings or to support activities that promote assistance to families who
may be eligible for NC’s health insurance;
3. Provide a brief report on lessons learned and/or suggestions to improve
the project, report quarterly an estimate of the number of families
assisted, and invite HRL staff to at least one of your SHAC meetings.

9. HRL Grant Agreement – Cont.
B. The North Carolina Pediatric Society Foundation will:
1. Provide a $1,000 grant per county for LEA(s) to use at your
discretion as described above between Nov. 16, 2011 and
September 30, 2012 to support HRL goals;
2. Host the Healthy and Ready to Learn Steering Committee and
provide regular updates to all agencies and organizations
represented plus LEA partners, and present at the SHAC meeting;
3. Inform the elementary school principals in your LEA about the
HRL participation after November 16, 2011, unless your system
prefers to do so directly. NOTE: Please inform your principals by
Nov. 16, 2011.

10. HRL Data Collection Form
Please enter the number of children/families who were provided
information through brochure, envelope stuffer, application, personal
assistance or at school events about Health Check/NC Health Choice
children’s insurance. Email completed forms to your HRL Local
Community Coordinator each quarter.
October - December 2011
Total # of families/children assisted this quarter:
Other/Notes:
January - March 2012
April – June 2012
July - September 2012

11. Preliminary Evaluation of Healthy and Ready to Learn
• HC/NCHC enrollment change in 16
pilot counties in 2009- 2010 through
March of the current school year,
2010-2011, compared to 2008-2009
• HRL counties continued to increase
enrollment for kindergarten-aged
children by over 3 percentage points
more than non-HRL counties
• These data provide preliminary
descriptive evidence suggesting that
the HRL initiative is effective
• Focus group results suggest HRL
“energized” the community to do
the outreach
• Final evaluation in Jan. 2012 (~9,000
KHA forms evaluated)

12. Preliminary Evaluation of Healthy and Ready to Learn
Distribution of outreach materials:
Year 1 (Jan. 2010-Sept. 2010), 16 pilot counties: 61,983
Year 2 (Oct. 2010 – Sept. 2011), 48 counties: 202,912
Total for both years: 264,895
Number of children/families assisted by school nurses or school staff:
Year 1 – approximately 1,000 between July 2011-Sept. 2011 for 16 pilot
counties (no data collected prior to)
Year 2 – approximately 56,300
Total – approximately 57,300

13. How to find uninsured children?
- Kindergarten Health Assessment Form
(It includes a check box for the parent to
indicate the child’s insurance status)
- Other forms and health assessments used at
your schools such as School Registration, Sports
Physicals, Field Trip forms. Add a questions
about insurance
- Follow up with outreach materials or in-person
information, as appropriate

15. Kindergarten Health Assessment Form
• Form is often NOT filled out completely when it arrives at schools
• Frequently, parents do not fill their part due to low literacy levels or not
realizing it is their responsibility
• Important to fill out form completely so the school staff has an entire
record on child's health
• Back side - under “Parent Complete”- identifies children who do not have
health coverage

16. Why is a complete Kindergarten Assessment Form
important?
 To track children’s health status and maintain a healthy lifestyle
 To save school staff’s time and make medical referrals easier
 To identify uninsured children and help them establish medical home
 To help enroll uninsured and eligible patients into NC’s children’s health
insurance programs

17. Health Check / NC Health Choice:
Keeping Students
Healthy & Ready to Learn
Norma Marti, NCDPH
(as separate presentation placed at www.NCPedsFoundation.org, under Orientation/Outreach Tools:
http://www.ncpedsfoundation.org/index.php?option=com_content&view=category&id=37&Itemid=63)

18. What can school staff and SHAC members do?
• Review school forms, such as the KHA form and others, to
check if child has health insurance
• Remind families to complete all “Parent complete” parts
on the KHA form
• Share promotional materials, an application form and
address of the local DSS with families of uninsured
children
• Parents are more likely to apply if they see income
guidelines based on family size so keep outreach materials
on hand
• Promote child health insurance at school events
• Implement at least three school-based outreach ideas
provided by HRL at your school

19. Examples of school-based child health insurance (CHI) outreach
strategies to implement at your school
Use existing health status assessments
• Send HC/NCHC envelope stuffer home with every child, along with a response
form to be returned to the child’s teacher (available from the “School Partnership”
link above)
• Ask parents to indicate the child’s current insurance status on school forms. Have
them sign it, provide contact information, and ask if they want to receive a
HC/NCHC application form
Existing communication infrastructures
• Use school voice mail systems to communicate a message to all parents or a
targeted group of parents like those whose children qualify for F/RP School Meals,
or who have newly enrolled kindergarteners
• Home-schooled children may have a list serve that can be utilized to reach that
population of students

20. Examples of school-based child health insurance (CHI) outreach
strategies to implement at your school
School-produced materials and forms
• Use Parent/Student Handbooks as an opportunity to educate about CHI.
(Information has been scripted for use in such a resource, see ‘School
Partnership” link). If the parent has to sign a document that they
reviewed in the Handbook, then a check box could be added to the form
for parents to indicate if they would like further information or to be
contacted about CHI
• Ask about insurance status through School Registration, Sports
Physicals, and other forms to promote CHI and follow up as appropriate.
Include where to turn for more information: www.NCHealthyStart.org or
go to local department of social services

21. Examples of school-based child health insurance (CHI) outreach
strategies to implement at your school
Local PTAs/PTOs
• The NC PTA is already involved in child health insurance outreach in some
local areas. Articles have been published in their statewide “NC Parent-
Teacher Bulletin” and the “Parent Resource Handbook” for PTA
Presidents. There are links from the NC-PTA web site to CHI web pages.
• Work with your local PTA to promote CHI
• All examples of school-based outreach strategies
are available at: www.ncpedsfoundation.org, under
Healthy and Ready to Learn, go to “Action Plan.”

22. What are other LEAs doing?
Central region:
• Use existing communication channels and partnerships to promote children’s
health insurance
• Link Healthy and Ready to Learn to existing school/ community priorities (e. g., as
SHAC goal)
• Prepare direct mailings to parents with a letter about HC/NCHC
• Send info and applications to parents when the school nurse is providing referrals
for vision or hearing screenings
• Send HC/NCHC envelope stuffers home with report cards
You can make a difference!

23. What are other LEAs doing?
Southwestern region:
• KINDERGARTEN REGISTRATION - parent cover letter
• Kindergarten preparation folders to parents (Cumberland)
• Parent liaison for migrants (Robeson)
• Parents interview with SHN and as they assist in child’s health care needs at Kindergarten
Registration
Most Successful Counties:
• Robeson - All Principals of Elementary Schools participated in HRL Awareness
Superintendant Luncheon
• Cumberland - WEBINAR for all elementary school staff
- PARENT NIGHT- HRL Local Community Coordinator and Carolina
Community Care HCC invited to emphasize NCHC/HC and to assist
parents with applications
• Gaston - 30+ community professionals (dentist, local pediatrician, Fire Chief, Police Chief,
etc) on SHAC for Community Awareness to promote HRL

24. What are other LEAs doing?
Northeastern region:
• Emergency cards include insurance question
• Locally produced forms sent to all students grade 1-12 and given to all new students who
enroll
Example: Onslow County Schools Health Services
HEALTH CARE INFORMATION
Student’s Name ______________________________________ Grade/Teacher ___________________
Where your student gets regular health care: Student has:
 1 Health Department  1 Medicaid  3 No Insurance
 2 Hospital Clinic  2 Private Insurance/HMO  4 Other:
_____________
 3 Community Health Center Doctor/ Practice Name:
 4 Private Doctor/HMO
_______________________________________________
 5 Other __________________ Dentist Name:
 6 No regular place
_______________________________________________
 I would like information on free/low cost health insurance for my student.
Forward to School Nurse

25. SNANC and Public Health:
Supporting Healthy and Ready to
Learn Project
Clementine Buford, Immediate Past President School Nurse Association of North Carolina
Jessica Gerdes, State School Nurse Consultant, NC Division of Public Health
“Working for a healthier and safer North Carolina”

26. #1 Coordinated School Health Approach
School
Health
Education Physical
Family & Education &
Community Physical
Involvement Activity
Staff School
Health Health
Promotion Services
Healthy
Nutrition
School
Services
Environment
Counseling,
Psychological &
Social Services
School Health Services +
Family/Community Involvement

27. Division of Public Health
• Long-term sustainability is critical
• Assuring access to care as a forethought, not
afterthought
• Institutionalizing the project
– Goal of State Division of Public Health
– Goal of Children and Youth Branch of DPH
– Goal of School Health Unit of DPH
“Working for a healthier and safer North Carolina”

29. School Nurses:
• Provide services to students and
families daily
• Play a vital role in both educating
and providing resources to
families
• Can make a difference

30. School Nurses:
• Know the impact of being an
uninsured student
• Look forward to
assisting in this project
• Know that healthy
Children learn better

31. HRL Project Strategies
• Focus on kindergarten – elementary school students
through School Nurse and Community
•Kindergarten Health Assessment
•There are steps in the kindergarten health
assessment process that would accomplish the HRL
objective
Physicians
Local health department clinics
School health centers
•Siblings of kindergarten students
•Teacher referral
•Student referral teams
•School Nurse Point of Service

32. YOU can make a difference!
10 HLR Actions Steps:
1. Share information about the Healthy and Ready to 3. Make sure ALL information
Learn and child health insurance programs, Health on the KHA form is complete
Check/ NC Health Choice, with school staff and all your and follow up on families who
SHAC members (This PowerPoint will be posted at: don’t fill out their part.
www.NCPedsFoundation.org under Orientation).
4. Hang a HC/NCHC poster so
2. Order free (English/Spanish) outreach materials, i.e. that families can see it.
fact sheets (D4, D4BR), envelope stuffers
(D3), applications (D6E, D6S) and poster (D5) from
www.NCHealthyStart.org , click on Order. For other
languages, check:
http://www.nchealthystart.org/outreach/index.html.
Add “HRL” under Department on order form from
NCHSF.

33. YOU can make a difference!
Actions Steps:
5. Give outreach materials to families 7. Create or implement some outreach ideas in your
with uninsured children and those school system from “School-based child health insurance
who mark “no insurance” on the KHA outreach strategies.” For example, share materials during
form. Be sure to share: a flier with kindergarten registration events or parent orientations, or
income guidelines (fact sheet or place a simple message to parents on your school’s voice
envelope stuffer), an application, and system.
the address of local DSS.
If your school has a Pre-K program, please reach out to
6. Consider following up with families to families of 4-year old children.
see if they need help enrolling and offer
them resources such as 8. Please help us keep track of the number of families
www.NCHealthyStart.org and local you assist. Every quarter we will ask for an approximate
DSS. number of families you have reached.

34. YOU can make a difference!
Actions Steps:
9. Call us if you need help with ordering materials, scripting a
message, need a cover letter to send to families, or want us to
mail you fliers with DSS addresses by county.
Local Community Coordinators for HRL are:
Laura H. Brewer (south/west region, office in Robeson
County), laura@ncpeds.org, 910-865-5507, Betty Macon
(north/east region, office in Halifax
County), betty@ncpeds.org, 252-822-3340, and India Foy
(central/western region, office in Guilford
County), india@ncpeds.org, 336-617-6628.
Visit www.NCPedsFoundation.org for outreach tools and
resources!
10. Share your success stories with us!

35. Healthy and Ready to Learn Initiative
Local Community Coordinators
Project Director
Ania Boer, ME, MA C: Central Region
1100 Wake Forest Road, Ste 200 NE: Northeast Region
India Foy, MPH
Raleigh, NC 27604 Greensboro, NC
Betty Macon
919 839-1156 336-617-6628 Roanoke Rapids, NC.
FAX: 919-839-1158 india@ncpeds.org 252-822-3340
ania@ncpeds.org betty@ncpeds.org
Alleghany Vance Northampton Gates Currituck
Ashe Surry Rockingham
Stokes Caswell Granville Warren
Person Hertford
Watauga Wilkes Halifax
Yadkin Alamance
Mitchell Avery Forsyth Orange Franklin Bertie
Caldwell Guilford Nash
Yancey Alexander Davie Durham
Madison Edgecombe Tyrrell
Burke Iredell Davidson Wake Martin Washington Dare
Randolph Chatham Wilson
Buncombe McDowell Catawba Rowan Pitt
Beaufort
Swain Haywood Lincoln Johnston Greene Hyde
Rutherford Cabarrus Montgomery Lee
Graham Henderson Harnett Wayne
Jackson
Transylvania
Polk ClevelandGaston Stanly Moore
Lenoir Craven
Mecklenburg
Cherokee Macon
Clay Cumberland Pamlico
Anson Richmond Hoke Sampson Jones
Union Duplin
Scotland Onslow Carteret
Robeson Bladen
Pender
S & SW: Southern & Southwestern Region Columbus New
Laura H. Brewer Hanove
St. Pauls/ Lumberton Brunswick
910-865-5507
laura@ncpeds.org
December 2010

36. North Carolina Pediatric Society Foundation
Healthy and Ready to Learn initiative team:
Steve Shore, MSW, Executive Director, NCPS-F
Ania Boer, ME, MA, Project Director, ania@ncpeds.org
Laura Brewer, Local Community Coordinator for south/western region
(office in Robeson County), laura@ncpeds.org, (910) 865-5507
India Foy, MPH, Local Community Coordinator for central/western region
(office in Guilford County), india@ncpeds.org, 336-617-6628
Betty Macon, Local Community Coordinator for northeastern region
(office in Halifax County), betty@ncpeds.org, (252) 822-3340
1100 Wake Forest Road, Suite 200
Raleigh, NC 27604
Phone: (919) 839-1156
Fax: (919) 839-1158
www.NCPedsFoundation.org

37. North Carolina Pediatric Society Foundation
Healthy and Ready to Learn initiative team:
Steve Shore, Executive Director
Ania Boer, Project Director
From Left:
Betty Macon, Local Community Coordinator
for northeastern region,
Laura H. Brewer, Local Community Coordinator for
south/western region,
India Foy, Local Community Coordinator for
central/western region

38. Thank you for your support of the
Healthy and Ready to Learn Initiative!
Q&A